Transitions between levels of dependency among older people receiving social care – a retrospective longitudinal cohort study in a Swedish municipality

Abstract

Background Knowledge is scarce on how needs for home help and special housing evolve among older people who begin to receive support from municipal social care. The purpose of this study was to describe baseline distributions and transitions over time between levels of dependency among older persons after being granted social care in a Swedish municipality. Methods Based on a longitudinal cohort study in a Swedish municipality, data was collected retrospectively from municipal records. All persons 65 years or older who received their first decision on social care during 2010 (n = 415) were categorized as being in mild, moderate, severe, or total dependency, and were observed until the end of 2013. Baseline distributions and transitions over time were described descriptively and analysed with survival analysis, with the Kaplan-Meier estimator, over the entire follow-up period. To test potential differences in relation to gender, we used the Cox-Proportional hazards model. Results Baseline distributions between mild, moderate, severe, and total dependency were 53, 16, 24, and 7.7%. During the first year, between 40 and 63% remained at their initial level of dependency. Among those with mild and moderate levels of dependency at baseline, a large proportion declined towards increasing levels of dependency over time; around 40% had increased their dependency level 1 year from baseline and at the end of the follow-up, 75% had increased their dependency level or died. Conclusions Older people in Sweden being allocated home help are at high risk for decline towards higher levels of dependency, especially those at mild or moderate dependency levels at baseline. Taken together, it is important that municipalities make use of existing knowledge so that they implement cost-effective preventative interventions for older people at an early stage before a decline toward increasing levels of dependency.

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“…These findings correlate with results of a longitudinal Swedish study that examined transitions between levels of dependency among 415 older people receiving supportive care over time [10]. Here, it was reported that a significant number of participants who were initially more dependent, transferred to a lower level of dependency (28%) within one year demonstrating improvements in overall health and quality of life [10]. However, it was also noted that 34% of participants with mild or moderate dependency transitioned to higher dependency levels within the same year [10].…”

“…Here, it was reported that a significant number of participants who were initially more dependent, transferred to a lower level of dependency (28%) within one year demonstrating improvements in overall health and quality of life [10]. However, it was also noted that 34% of participants with mild or moderate dependency transitioned to higher dependency levels within the same year [10].…”

A qualitative exploration of professionals’ perspectives on the implementation of reablement intervention programs in community care

“…As the aging population continues to grow and individuals continue to live longer, the complexity of care needs and health issues also increases, often involving multiple health conditions 19 . To continue to meet these changing needs and adhere to the wish of older adults to age in place, care provision and health care interventions also become more complex.…”

Latent class of multidimensional dependency in community-dwelling older adults: evidence from the longitudinal ageing study in India

“…Therefore using only any single dependency measure to understand the complexity and heterogeneity of the dependency of older adults is not sufficient. Also, during the ageing process, older adults will experience a dependency transition, meaning that as age progresses, the dependency status of older adults will change from mild to severe dependency [ 15 – 17 ]. Hence, a better understanding of the diversity of functional activities may contribute to the knowledge about the heterogeneity of dependency.…”